Department of Science and Technology/National Research Foundation, Vaccine Preventable Diseases and Medical Research Council, Respiratory and Meningeal Pathogens Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
PLoS One. 2011;6(11):e27929. doi: 10.1371/journal.pone.0027929. Epub 2011 Nov 28.
Highly active antiretroviral treatment (HAART) programs have been associated with declines in the burden of invasive pneumococcal disease (IPD) in industrialized countries. The aim of this study was to evaluate trends in IPD hospitalizations in HIV-infected adults in Soweto, South Africa, associated with up-scaling of the HAART program from 2003 to 2008.
Laboratory-confirmed IPD cases were identified from 2003 through 2008 through an existing surveillance program. The period 2003-04 was designated as the early-HAART era, 2005-06 as the intermediate-HAART era and 2007-08 as the established-HAART era. The incidence of IPD was compared between the early-HAART and established-HAART eras in HIV-infected and-uninfected individuals.
A total of 2,567 IPD cases among individuals older than 18 years were reported from 2003 through 2008. Overall incidence of IPD (per 100,000) did not change during the study period in HIV-infected adults (207.4 cases in the early-HAART and 214.0 cases in the established-HAART era; p = 0.55). IPD incidence, actually increased 1.16-fold (95% CI: 1.01; 1.62) in HIV-infected females between the early-and established-HAART eras (212.1 cases and 246.2 cases, respectively; p = 0.03). The incidence of IPD remained unchanged in HIV-uninfected adults across the three time periods.
Despite a stable prevalence of HIV and the increased roll-out of HAART for treatment of AIDS patients in our setting, the burden of IPD has not decreased among HIV-infected adults. The study indicates a need for ongoing monitoring of disease and HAART program effectiveness to reduce opportunistic infections in African adults with HIV/AIDS, as well as the need to consider alternate strategies including pneumococcal conjugate vaccine immunization for the prevention of IPD in HIV-infected adults.
在工业化国家，高效抗逆转录病毒治疗（HAART）项目与侵袭性肺炎球菌病（IPD）负担的下降有关。本研究的目的是评估 2003 年至 2008 年抗逆转录病毒治疗方案扩大后，南非索韦托感染艾滋病毒的成年人中 IPD 住院的趋势。
通过现有的监测计划，从 2003 年至 2008 年确定了实验室确诊的 IPD 病例。2003-04 年被指定为早期 HAART 时代，2005-06 年为中期 HAART 时代，2007-08 年为既定 HAART 时代。在 HIV 感染者和未感染者中，比较了早期 HAART 和既定 HAART 时代 IPD 的发生率。
2003 年至 2008 年期间，报告了 2567 例年龄大于 18 岁的 IPD 病例。在研究期间，HIV 感染者成年人的 IPD 总发病率（每 100,000 人）没有变化（早期 HAART 为 207.4 例，既定 HAART 为 214.0 例；p=0.55）。在早期和既定 HAART 时代之间，HIV 感染女性的 IPD 发病率实际上增加了 1.16 倍（95%CI：1.01；1.62）（分别为 212.1 例和 246.2 例；p=0.03）。在三个时期，HIV 未感染者成年人的 IPD 发病率保持不变。
尽管在我们的环境中，艾滋病毒的流行率保持稳定，并且更多地推出了抗逆转录病毒治疗艾滋病患者，但 HIV 感染成年人的 IPD 负担并未减轻。该研究表明，需要继续监测疾病和 HAART 方案的效果，以减少非洲 HIV/AIDS 成人的机会性感染，还需要考虑替代策略，包括肺炎球菌结合疫苗免疫接种，以预防 HIV 感染成年人的 IPD。
